Meningitis – Bacterial and Meningococcal Disease

🧭 When to suspect

Bacterial meningitis and meningococcal disease are medical emergencies that can kill a previously well person within hours, so the threshold for suspicion must be low and the response immediate.

Strongly suspect bacterial meningitis in anyone with the red-flag combination of fever, headache, neck stiffness and an altered level of consciousness or cognition (confusion, delirium or drowsiness).

The principal pathogens beyond the neonatal period are Neisseria meningitidis and Streptococcus pneumoniae.

In babies and young children the signs are non-specific, so clinical suspicion must do the work.

Above all, do not wait for the rash: the non-blanching petechial or purpuric rash is a late sign of septicaemia, whereas these appear earlier:

• Cold hands and feet

• Severe limb, leg or joint pain

• Pale or mottled skin

Keep the threshold lowest in higher-risk groups:

• Infants

• Adolescents and first-year university students (close living in halls)

• The unimmunised

• The immunocompromised – asplenia or hyposplenism, sickle cell disease, and complement deficiency (including patients on eculizumab or ravulizumab)

Recognise early and transfer fast – antibiotics must never delay the ambulance.

Source: NICE NG240